HIV Related Neuropathy

Aka: HIV Related Neuropathy, Neuropathy in HIV, HIV Peripheral Neuropathy, HIV Associated Polyneuropathy

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II. Types

  1. Distal Sensory Polyneuropathy (most-common HIV-associated Neuropathy)
    1. Common complication at any stage of HIV Infection
    2. Varicella Zoster Virus (VZV) commonly involved
    3. Toxic Peripheral Neuropathy
      1. HIV Treatment with nRTI agents, especially older agents (e.g. DDI or Didanosine)
  2. Demyelinating Neuropathy
    1. Resembles Guillain-Barre
    2. Seen in early HIV
  3. Ascending sensorimotor Neuropathy with Incontinence or polyradiculopathy
    1. Cytomegalovirus (CMV) infection
      1. May involve the spinal cord segment
      2. May present with a painful extremity

III. Symptoms: Distal Sensory Polyneuropathy

  1. Distal lower extremity numbness, Paresthesias, or pain

IV. Signs: Distal Sensory Polyneuropathy

  1. Decreased ankle Deep Tendon Reflexes
  2. Decreased lower extremity Sensation (esp. sharp and vibratory Sensation)

V. Differential Diagnosis

  1. See Peripheral Neuropathy

VI. Management

  1. See Peripheral Neuropathy
  2. General measures
    1. Eliminate Neurotoxins (e.g. older Antiretroviral agents)
    2. Control comorbidities (e.g. Diabetes Mellitus, Alcohol Abuse)
    3. Reduce HIV Viral Load
  3. Symptomatic management
    1. Gabapentin (Neurontin)
    2. Tricyclic Antidepressants

VII. References

  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]

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